Meridian eft enrollment 2026

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01. Edit your meridian eft enrollment online
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02. Sign it in a few clicks
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03. Share your form with others
Send meridian health plan eft via email, link, or fax. You can also download it, export it or print it out.

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Click ‘Get Form’ to open the meridian EFT enrollment in the editor.
In Part I, select the reason for submission by checking one of the options: New EFT Authorization, Change Existing EFT, or Cancel EFT.
Proceed to Part II and enter the Provider/Supplier Information. Fill in the legal business name, street address, city, state, zip code, tax identification number (SSN or EIN), and National Provider Number (NPI).
In Part III, provide Financial Institution Information. Include the institution's name, city/town, state, telephone number, contact person’s name, routing transit number (nine digits), depositor account number, and type of account (checking or savings).
Complete Part IV by entering the Primary Contact for your organization. Fill in their name, title, telephone number, and email address.
In Part V, provide Electronic Remittance Advice Information including EDI Value Added Network/Clearinghouse details and confirm if you wish to receive paper remittance advice.
Review Part VI for Authorization. Ensure all information is accurate and that you have authority to enroll the provider identified in this form.
Finally, sign in Part VII as an Authorized/Delegated Official. Print your name, title, telephone number, email address and date before submitting.

Start filling out your meridian EFT enrollment form online for free today!